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A case of conversion hepatectomy for huge ruptured hepatocellular carcinoma after transarterial embolization and lenvatinib therapy

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Abstract

We herein report a successfully treated case of huge ruptured hepatocellular carcinoma (HCC) by conversion hepatectomy after transarterial embolization (TAE) and lenvatinib therapy. A 33-year-old male patient with right hypochondralgia and liver tumor was referred to our hospital. He had a history of surgery for heart malformation. The tumor at the right lobe was 15 cm in diameter with bloody ascites. Right atrial thrombus 4.5 cm in diameter and marked cardiac dilatation were observed. TAE with ethanol suspended in lipiodol and gelatin sponge achieved hemostasis of the ruptured HCC. Although viable HCC remained after TAE, surgical treatment was abandoned because of abdominal wall invasion and his heart function. Lenvatinib and rivaroxaban were then initiated for HCC and atrial thrombus, respectively. Lenvatinib treatment resulted in a reduction in tumor marker levels and the tumor size. First, we planned conversion hepatectomy after 5 months of lenvatinib. However, recurrence of atrial thrombus prompted us to put off the surgery, and lenvatinib was re-administered. After improvement of atrial thrombus, we finally performed conversion hepatectomy 10 months after starting lenvatinib administration. The tumor was completely removed by combined resection of the diaphragm, and the patient has been doing well without any signs of recurrence.

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Authors and Affiliations

  1. Department of Gastroenterology, National Hospital Organization Takasaki General Medical Center, 36 Takamatsu-cho, Takasaki, Gunma, 370-0829, Japan

    Atsushi Naganuma, Yuhei Suzuki, Takashi Hoshino, Hidetoshi Yasuoka, Yuki Tamura, Hiroaki Naruse & Satoru Kakizaki

  2. Department of Surgery, National Hospital Organization Takasaki General Medical Center, 36 Takamatsu-cho, Takasaki, Gunma, 370-0829, Japan

    Hiroshi Tanaka, Keitaro Hirai, Ichiro Sakamoto & Tetsushi Ogawa

  3. Department of Gastroenterology, Gunma Saiseikai Maebashi Hospital, 564-1 Kamishindenmachi, Maebashi, Gunma, 371-0821, Japan

    Takeshi Hatanaka

  4. Department of Clinical Research, National Hospital Organization Takasaki General Medical Center, 36 Takamatsu-cho, Takasaki, Gunma, 370-0829, Japan

    Satoru Kakizaki

Authors
  1. Atsushi Naganuma
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  2. Yuhei Suzuki
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  3. Takashi Hoshino
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  4. Hidetoshi Yasuoka
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  5. Yuki Tamura
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  6. Hiroaki Naruse
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  7. Hiroshi Tanaka
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  8. Keitaro Hirai
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  9. Ichiro Sakamoto
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  10. Tetsushi Ogawa
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  11. Takeshi Hatanaka
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  12. Satoru Kakizaki
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Corresponding author

Correspondence to Satoru Kakizaki.

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All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Naganuma, A., Suzuki, Y., Hoshino, T. et al. A case of conversion hepatectomy for huge ruptured hepatocellular carcinoma after transarterial embolization and lenvatinib therapy. Clin J Gastroenterol 15, 177–184 (2022). https://doi.org/10.1007/s12328-021-01558-5

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  • DOI: https://doi.org/10.1007/s12328-021-01558-5

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